Arising from respiratory infections such as TB and HIV, tobacco smoking and nutritional impairment, chronic lung disease (CLD) affects around one in five adults in Africa, and is a major threat to health. Patients with breathlessness related to CLD create large but silent burden of human suffering, damage to the economy through lost productivity and disability, and direct health service costs with frequent and prolonged hospital admissions. People with CLD are prone to breathlessness, inactivity, de-conditioning, declining health status and prognosis. CLDs are disproportionately prevalent in deprived populations and many sufferers can neither afford the drugs nor transport to medical clinics. While non-communicable diseases are now recognised as a major public health problem in Africa, CLDs are neglected as a health priority.
While medication may improve lung function and symptoms they do not change prognosis or rate of decline in lung function or health status. However these important systemic effects of CLDs are amenable to treatment with pulmonary rehabilitation (PR) which is a programme of exercise, education and self management. There is strong evidence that PR improves health status, exercise capacity, social functioning and is recommended in international guidelines. PR involves existing local resources such as nurses, doctors, physiotherapists and clinic staff. PR allows patients to help each other and themselves, without major capital outlay or equipment. PR offers a major and radical new approach to CLDs, an important neglected group for whom no effective therapy is available. A literature review found no evidence of pulmonary rehabilitation being used in Sub Saharan Africa.
The objective of this application is to develop PR to a point where it may be deployed widely in East Africa and assessed in a large trial. The main research questions are:
- What is the optimal design of the PR programme?
- What are the patient recruitment and retention strategies?
- What are the optimal assessment strategies and outcome measures?
- How can the training and roll-out be best achieved?
The study has quantitative and qualitative elements. The pilot PR programme will be implemented at Mulago hospital for 3 more cohorts, totalling 30-40 people. Quantitative data will be recorded on recruitment, uptake and completion of PR. A range of measures will be assessed, including exercise capacity and quality of life, satisfaction, and evaluation of chest pains. In the qualitative study, detailed interviews will be held with 25 participants who have completed the programme and 5 interviews will be conducted with people who did not take part or complete PR, focusing on barriers to attending or completing PR. A focus group and up to 5 in depth interviews with stakeholders will explore practical issues of running and extending PR in Africa. Thematic analysis will be performed by Ugandan researchers in local languages initially with further framework analysis in collaboration with the UK team. To inform the development of a full grant application the researchers will host a meeting of all stakeholders to disseminate the findings of this work and develop the strategy for rolling out PR in East Africa.